Gut microbiota plasticity is correlated with sustained weight loss on a low-carb or low-fat dietary intervention

Background: Obesity is a complex global health challenge. Although both low-carbohydrate (low-carb) and low-fat diets can lead to weight loss, there is typically substantial variability in weight and related outcomes for both diet approaches among obese but otherwise healthy adults. Elucidating individual characteristics that might contribute to sustained weight loss is critical to developing effective dietary intervention strategies. We hypothesized that structural differences in the gut microbiota explained some portion of the weight loss variability among people randomized to either a low-carb or low-fat diet, possibly related to its effects on dietary compliance. Results: Our study included two staggered cohorts of obese adults enrolled in the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) study - a randomized clinical trial of either a low-fat or low-carb diet. In the discovery cohort (n=66), 161 pre-diet fecal samples were sequenced in addition to 157 samples collected after 10-weeks of dietary intervention. In the validation cohort (n = 56), 106 pre-diet fecal samples were sequenced. Pre-diet taxonomic features, such as the Prevotella/Bacteroides ratio, correlated to weight loss in the discovery cohort were not confirmed in the validation cohort. The most robust finding in the discovery cohort indicated that gut microbiota plasticity was linked to 12-month weight loss in a diet-dependent manner; subjects with higher sustained weight loss on a low-fat diet had higher pre-diet daily plasticity, whereas those most successful on the low-carb diet had greater microbiota plasticity over 10 weeks of dietary intervention. Unfortunately, because sample frequency and timing was quite different in the validation cohort, the relationship between plasticity and weight loss could not be studied in this group. Conclusions: These findings suggest the potential importance of gut microbiota plasticity in sustained weight loss. We highlight the importance of evaluating kinetic trends and in assessing reproducibility in studies of the gut microbiota.